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General NPI Number Information
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NPI Number | 1689247603
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Entity Type | Individual
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Provider Name | GRICEL VAZQUEZ DMD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 3009 E 4TH AVE
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City | HIALEAH
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State | FL
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Zip | 33013-3210
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Country | US
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Telephone | 305-691-1616
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Fax |
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Provider Business Mailing Address
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Address Line | 770 W 71ST PL
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City | HIALEAH
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State | FL
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Zip | 33014-4827
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Country | US
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Telephone | 786-436-6541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN26304
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License Number State | FL
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